"Prime-Agers" Need New and Improved Insurance Options

Identification of strategies to expand coverage to persons aged 55 to 64

During 2001 and 2002, researchers at the Urban Institute — a nonpartisan economic and social policy research organization in Washington — studied the facts and issues related to health insurance coverage for Americans ages 55 to 64. Eight percent of the 40 million who are uninsured in the United States fall into this age group.

The project included the preparation of background papers and roundtable discussions among experts about policy options for expanding affordable coverage to this group.

Key Findings

Key findings from the background papers included:

  • About 1.4 million workers from ages 55 to 64 do not have employer-subsidized insurance.
  • Thirty-seven percent of prime-agers with incomes below 200 percent of poverty and 22 percent in poor health do not have group health coverage through their employer or through public programs.
  • Among those without employer-subsidized insurance or public coverage, prime-agers are substantially more likely to have private individual insurance than their younger counterparts, highlighting the importance that prime-agers place on having health insurance.
  • One-third of women in this age group depend on their husbands for group coverage, making them vulnerable to coverage loss if their husband dies or loses coverage, or if the couple divorces.
  • Once prime-agers exhaust their COBRA Health Benefits (continuing health coverage mandated under the Consolidated Omnibus Budget Reconciliation Act of 1986), they may face much higher premiums, particularly if they are in poor health and have limited employment options.

Key findings and recommendations from the expert group roundtables included the following:

  • COBRA extension and state risk pools are only partial solutions.
  • Two comprehensive policy approaches show promise for improving insurance coverage rates:
    • Building on existing structures of insurance with some modest reforms and relying on subsidies through vouchers or tax credits.
    • Creating a more structured program with private plan choices offered and managed by the government.

Funding

The Robert Wood Johnson Foundation (RWJF) supported this project through a grant of $136,608.

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